Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO165148 | OR |
Y | 208D00000X | General Practice Physician | DO165148 | OR |
NPI | 1205185428 |
---|---|
Provider Name | Dr. Gian Andrian Tricomi |
First Address | Portland, OR 97296-0122 |
Second Address | Portland, OR 97210-3253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2012 |
Last Update Date | 03/07/2019 |